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M ECHANICAL.INSPECTOR RECORD I <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lVlisc. Equipment <br />Duct Work <br />Pre- Insu lation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type II Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />!nstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />Meter Release rx <br />FINAL G-hrrl)qaDpfr0 <br />Notes, Remarks, Etc.al \l/ <br />\7 <br />olvNIiR tlt;tLl)I.,R <br />I hcrcby effum undcr Fmlty of Isjury that I m cxetrpt from thc Cotrtrutffi' Licup trw for tlE following rc&sn (Src.7031.5 | <br />Busincss and Profcssion Code): Any City or County which rcquires ! lEmit ro @[s|rcL sltq, itrprcrc, dcmlish or rcpsir any . <br />struclurc, [ri,r lo iis issure, also rcquircs lhe spplicet for such pcrmit to fib s sigrcd statemnt lhat hc or shc b liccnsd pumalll - <br />to the Fovisions of the Contrscaor's Liccnrcd trw (Chaptcr 9. Comncing with Section 70fl) of Division 3 of thc Businc$ 8od , <br />Profcsiirns Code) or rhat hc or she is ercmpt thcrcfrom 8nd thc b&sis for the allcged cxctr{rtion. Aoy viohtion of Setion 703 1.5 by ony r <br />applicrnl for I pcmil subj$ls thc rpplicsnl to r civil pemhy of not mrc than fivc hundrcd dollus ($50O). <br />_1. as owncr of thc proprty. or my cmployees with wagcs as thcir rch compcnsation. willdo the work and ttte stnrcture is not <br />intcndcd or offercd for salc (Scc.7044. Business and Professions Codc: The Contractor's Liccnsc l.aw does nol apply to an owncr of <br />thc proFrcrty who builds or irrproves thereon. and who docs such work himself or hersclf or through his or her own employccs. <br />provided that such improvenrnts arc not intcnded or offercd for sale. lf. however. thc building or improvcnrcnt is sold within onc )aar <br />of complction. thc Owncr Builder will have the burdcn of proving that hc or she did not build or impmve the propctty for thc purynse of <br />sale). <br />-1. <br />as owncr of thc proFrcrty. am cxclusivcly contracting with liccnsed contractors to construct thc proict (Sec. 7M4. Business <br />and Prrofcssbn Codc: Thc Contractor's Liccnsc Law does not apply lo an owner of propcrty who builds or improves thercon. <br />and who contracts for such proicts wilh a Contracto(s) liccnscd pursuanl to the Contraclor's License Law). <br />-l <br />am exempt undcr Scction-. B. & P.C. for this reason. <br />Date: <br />WORKERS' COMPENSATION <br />DECLAITATION <br />I hercby affirm undcr ;rcnalty of pcrjury onc of thc following declarations: <br />-l <br />havc and will nuintain a Certificate of Consent to Self-lnsurc for workcrs' compensation, fl.s pmvided for by Section 3700 of the <br />labor Codc. for thc grcrformancc of the work for which the pcT mit ls issucd. <br />-l <br />havc and will rnaintain workcrs'compensation insurarrcc. as rcquircd by Section 3700 of thc Labor Code. for lhe pcrformancc of <br />thc work for which this pcrmit is issucd. My workers' comlrcnsation insurance carricr and policy number are: <br />Policy Nunrbcr: Expires: <br />-l <br />ccrtify that in thc ;rrfornuncc of thc work for which this permit is issucd. I shall not cmploy any pcrson in any manncr <br />so as to bccomc subject to thc workers' comgrcnsation laws of Calitbrnia. and agrcc that if I should bccornc subject to thc <br />workcrs' colnlrcnsation provisions of Section 3700 of thc l-abor Codc. I shall. tbrthwith comply wilh those provisions.. <br />WARNING: Failurc to sccure workcrs' compensation covcragc is unlawful. and shall subjcct an cmplo),er to criminul Jrenalties and <br />civil fines up to onc hundred thousand dollars ($100.0m). in addition to the cost of compensation. damages as providcd for the <br />Scction 3076 of thc l-ahor Codc, intercst and attorney's fees, <br />LICENSED CON'IRACTOR <br />DFCLARA'TION <br />t hcrcby atllrm undcr pcnaltyof pcrjury that I anr liccnscd undcr provision ol'Chaptcr 9 (cottrnrcncing u'ith Scclion 7Un) of l)ivision 3 <br />of thc Busincss alrd Prol'cssions Code. aml rny liccnsc is in t'ull t'orcc arxl clfccl. <br />License Class: Liccnse Numbcr: <br />I ):rlt.( 'rrrrl rcrclrrr' <br />CONS TRUCTION LENDING AGENCY <br />I hcrcby alfirnr undcr pnalty ofpcrjury rhol thcre is a conslruction lcnding rgcncy for lhc pcrformancc oflhc work for which lhis tsnlit i\ <br />issucd (Scc. 1097. Civ. C.). <br />lrndcr's Namc: <br />lrndcr's Addrcss: <br />APr, ,.ANT n"cLAM <br />I hcrcby allirnt undcr pcnalty of pcrjury onc of thc ttrlkrwing dcclarations: <br />DcrnoIition Pcrrnits-Asbcstos Notilicalion Fcderal Regulations (Titlc 40. Part6) <br />-Rcquircd <br />Lcttcr of Notificalion <br />_l certify that the fedcralregulations rcgarding asbcstos rcmovalare not applicabh to this pmject. <br />--l ccrtify that I havc rcad this application and state that thc atxrve informatiorr is corrcct. I agrcr to conrply with all City and County <br />ordinanccs arrd Statc l-arvs rclating lo building construclion. and hercby uuthorizc rcprescniltivcs of this City and <br />ahove nrntioncd proFrcrty <br />Applicant or Agcnl <br />Permitcc nanrc <br />purlx)scs. <br />l)alc:c/';;/;;'- <br />0wner: <br />Carrier: <br />Su,s(rul L